1. Heard on the point of admissibility of the complaint. Perusal of the complaint reveals that Sh.Gurbachan Singh(hereinafter in short to be described as ‘complainant’) has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against ICICI Lombard General Insurance Company Limited, TF-1-5, 3rd Floor, Kunal Tower, 88 The Mall, Ludhiana, Opp.Axis Bank, through its Manager (hereinafter in short to be described as ‘Op’) with the brief averments that the complainant had obtained Health Insurance Policy from the Insurance Company i.e. Policy No.40341/FPP/7553780/00/000 commencing from 26.11.2008 and the said policy was for a period of two years having maturity date of 25.11.20104. The complainant had paid premium to the insurance company since last 6 years. The complainant on 1.11.2014 was diagnosed for Gallstone disease and intended to take benefit of cashless policy and accordingly, submitted his claim to the insurance company requesting them for cashless benefit from Satguru Partap Singh Apollo Hospital, Ludhiana, but the insurance company did not accept the genuine request of the complainant and replied vide their email dated 11.11.2014 vide claim UHIC NO.100656283 that “as per document and information known hypertension since 10 years on treatment. Based on the documents submitted in support of the claim, insured is suffering with (HTN)prior to the policy commencement. The insurer did not disclose the same at the time of policy commencement. The claim stands rejected and the policy shall be null and void due to non-disclosure”. For details of applicable policy terms refer part II, clause (I) of the policy schedule. The insurance company made reference to the clause of pre-existing illness with a malafide intention just to refuse the cashless benefit claim of the complainant whereas pre-existing illness as per definition so provided in the policy reflects as “Any condition”, ailment or injury had signs or symptoms, and/or were diagnosed, and/or received medical advice/treatment, within 48 months prior to the first individual health policy with the company. The complainant was only diagnosed with the Symptomatic Gallstone disease only on 1.11.2014 and not exactly two years before taking the first individual health policy. The complainant clearly does not fall within the category of pre-existing ailment as the same were diagnosed only on 1.11.2014. The insurance company has proved to be deficient in their service by not accepting the cashless benefit to the policy despite assurance in the policy that there is guaranteed cashless benefit, but they have failed to abide by their own assurance. Hence, this complaint.
2. It is apparently clear from the contents of the complaint that the complainant has sought the relief that the OP be directed to reimburse the cost of treatment to be conducted and compensation of Rs.4,50,000/- and Rs.20,000/- as litigation expenses to him. However, it appears that the complainant has not got admitted in any hospital nor he got any treatment under the alleged policy nor he has spent on his treatment nor he lodged any claim with the OP for reimbursement of the claim. The complainant is seeking relief in anticipation on the basis of the alleged policy which has already expired on 25.11.2014, whereas, the present complaint has been filed on 10.12.2014.
3. During the course of arguments, learned counsel for the complainant has conceded that this policy was issued by the OP from their office at Pune. However, the payment of the premium was received by the OP at Ludhiana. But the complainant has not placed on record any such documents, from which, it could be presumed that the policy document was executed at Ludhiana and the payment was made at Ludhiana. So, this Forum has got no territorial jurisdiction to try and decide the present complaint.
4. Section 11 of the Consumer Protection Act, 1986 pertains to jurisdiction of the District Forum to try and entertain the complaint, which provides as under:-
i)Subject to the other provisions of this Act, the District Forum shall have jurisdiction to entertain complaints where the value of the goods or services and the compensation, if any, claimed does not exceed rupees twenty lakhs.
ii)A complaint shall be instituted in a District Forum within the local limits of whose jurisdiction,
a)the opposite party or each of the opposite parties, where there are more than one, at the time of the institution of the complaint, actually and voluntarily resides or carries on business or has a branch office or personally works for gain; or
b)any of the opposite parties, where there are more than one, at the time of the institution of the complaint, actually and voluntarily resides, or carries on business or has a branch office or personally works for gain, provided that in such case either the permission of the District Forum is given, or the opposite parties who do not reside, or carry on business or have a branch office or personally work for gain, as the case may be, acquiesce in such institution; or
c)the cause of action, wholly or in part, arises.
5. From the above provisions, we are of the opinion that no cause of action accrued wholly or in part to the complainant at Ludhiana and it appears that this Forum has got no territorial jurisdiction to entertain and decide the present complaint.
6. So, in view of the above discussion, we do not admit the complaint of the complainant as the same is not maintainable as barred by jurisdiction and being pre-mature. Copy of the order be sent to the complainants free of cost and thereafter, file be consigned to the record room.
(Sat Paul Garg) (R.L.Ahuja)
Member President
Announced in Open Forum.
Dated:26.12.2014
(Gurpreet Sharma)
